COVID-19 telehealth and other virtual services eligible for risk adjustment

Medicare-covered services Qualifies for CRA Qualifies for MRA Physician location Submission place of service (POS) Common CPT® and HCPCS codes Telehealth (interactive audio telecommunication simultaneously with video telecommunication) X X X Home/office/facility Use CPT telehealth modifier “95” with any POS** 99201 – 99215
(office or outpatient visit)

G0425 – G0427
(telehealth consultations, emergency department or initial inpatient) Telephonic visit (audio only) X X Home/office/facility Any POS 99441 – 99443 Virtual check-in (5 to 20 minute visit) X X X* Home/office/facility Any POS G2010, G2012, G2252 E-visit (use of patient portal) X X Home/office/facility Any POS 99421, 99422, 99423
* G2010, G2012 and G2252 qualify for risk adjustment encounter data system (EDS) submission and should be used for visits that use interactive audio telecommunication simultaneously with video telecommunication. Humana maintains that any service rendered that is audio only does not meet the face-to-face requirement for risk adjustment. Therefore, if an audio-only visit is conducted, use the telephonic evaluation and management (E/M) codes (e.g. 99441 − 99443), as appropriate.

** Effective 1/1/2022, for a service provided via telehealth (i.e., modifier ‘95’ is used), there are now two code options to indicate the place of service (POS): 1) POS 02 for telehealth services provided other than in patients home, or 2) new POS 10 for telehealth services provided in patients home (which is a location other than a hospital or other facility where the patient receives care in a private residence).